Clinical Care Specialist at Discovery Limited

About the Job

Key Purpose

• To holistically review the needs of clinically complex members and coordinate their care in the most appropriate setting, liaising with internal and external stakeholders to ensure the best clinical outcomes.

Key Outputs

• Perform health assessments on patients in order to identify individual patient risk factors
• Perform interventions to influence individual patient risk
• Promote behavior change to ensure greater treatment compliance and condition management
• Authorising of admissions and treatment as per agreed protocols
• Assist members with clinical related queries
• Proactively assist complex member with understanding their plan benefits and maximizing their use to effect risk savings in the long term
• Monitor patient progress through ongoing patient interaction and follow-up.
• Co-ordination of integration of care including social services where appropriate.
• Maintain relationships between key internal and external stakeholders
• Refer to other departments where appropriate to ensure that the relevant benefits are provided

Competencies

The following competencies are required to be successful in the role:

• Compassion: Genuinely cares about people; is concerned about their work and non-work problems; is available and ready to help; is sympathetic to the plight of others not as fortunate; demonstrates real empathy with the joys and pains of others.
• Customer Focus: Is dedicated to meeting the expectations and requirements of internal and external customers; gets first-hand customer information and uses it for improvements in products and services; acts with customers in mind; establishes and maintains effective relationships with customers and gains their trust and respect.
• Learning on the fly: Learns quickly when facing new problems; a relentless and versatile learner; open to change; analyzes both successes and failures for clues to improvement; experiments and will try anything to find solutions; enjoys the challenge of unfamiliar tasks; quickly grasps the essence and the underlying structure of anything.
• Dealing with Paradox: Can act in ways that seem contradictory; is very flexible and adaptable when facing tough calls; can combine seeming opposites like being compassionately tough, stand up for self without trampling others, set strong but flexible standards; can act differently depending upon the situation; is seen as balanced despite the conflicting demands of the situation.

Requirements

The following requirements are Essential:

• Matric
• Registered Nurse qualification or Enrolled Nurse (working under supervision of RN)
• Enrolled nurse must have MCP or AIB experience
• Valid SANC registration
• MS Office
• At least 3 years clinical nursing experience, post training

The following requirements are advantageous:

• Managed care experience
• Discovery Health system knowledge and experience